Psychiatry 2008 - September 2008 - (Page 43)

The Interface complications, including nonadherence to medical treatment. In this installment of The Interface, we review recent empirical studies on the topic of alcohol/substance misuse and nonadherence with medical treatment. We have elected to review only contemporary studies (i.e., the majority have been published over the past five years) and only those that relate to alcohol/substance usage in relation to medical, not psychiatric, treatment adherence. Following this review, we conclude that alcohol and substance misuse unequivocally contributes to nonadherence with medical treatment regardless of illness type, ethnicity of the population under study, or methodology of the investigation. NONADHERENCE IN HUMAN IMMUNODEFICIENCY VIRUS TREATMENT In the area of alcohol/substance misuse and treatment nonadherence, studies over the past five years involving human immunodeficiency virus (HIV) are the most numerous. We will first review, by date of publication, studies with US patient samples and then studies from other countries. US studies. In a 2003 study, Tucker and colleagues examined 1,910 individuals with HIV infection to assess their adherence to antiretroviral medication “during the past week.”1 In this sample, nonadherence was associated with participants’ use of cocaine, amphetamines, or sedatives in the past month as well as moderate-toheavy alcohol intake. In 2004, Ingersall reported that among 120 individuals on antiviral therapy for HIV infection, recent crack cocaine and heroin use reduced treatment adherence.2 Hinkin and colleagues examined 148 HIV-positive adults and found that current drug abuse/dependence, but not alcohol [SEPTEMBER] ALCOHOL/SUBSTANCE MISUSE AND TREATMENT NONADHERENCE: Fatal Attraction by Randy A. Sansone, MD, and Lori A. Sansone, MD Psychiatry (Edgemont) 2008;5(9):43–46 This ongoing column is dedicated to the challenging clinical interface between psychiatry and primary care—two fields that are inexorably linked. ABSTRACT Alcohol and substance misuse have a variety of potential ramifications. In this edition of The Interface, we discuss studies that relate to alcohol/substance misuse and medical treatment nonadherence. Despite illness type, population characteristics, or adherence measures, studies are fairly consistent—alcohol and substance misuse reduce patient adherence with medical treatment. INTRODUCTION Alcohol and substance misuse may result in a number of potential psychological, legal, and health Psychiatry 2008 43

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Psychiatry 2008 - September 2008 Editor’s Message Editorial Advisory Board Contents Psych Rx Letters to the Editor Use of Benzodiazepines in the Treatment of Anxiety Functional Neurosurgery in the Treatment of Severe Obsessive Compulsive Disorder and Major Depression: Overview of Disease Circuits and Therapeutic Targeting for the Clinician Treatment of Comorbid Adolescent Cannabis Use and Major Depressive Disorder Risperidone Long-acting Injections: Successful Alternative Deltoid Muscle Injections for Refractory Schizophrenia Alcohol/Substance Misuse and Treatment Nonadherence: Fatal Attraction Transforming the Psychiatric Inpatient Unit from Short-term Pseudo-asylum Care to State-of-the-art Treatment Setting Journal Watch Classified Advertising Information for Authors

Psychiatry 2008 - September 2008

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